老年科患者病原菌分布及耐药性分析

Distribution and antimicrobial resistance of clinically isolated pathogens in a geriatrics department

摘要:

目的了解某院老年科2013年临床分离病原菌分布及耐药性，为临床用药提供参考。方法对2013年1—12月老年科患者送检临床标本中分离的病原菌分布及耐药情况进行统计分析。结果1 896株病原菌中, 革兰阴性（G-）菌1 289株(占67.99%)，革兰阳性(G+)菌493株(占26.00%），真菌114株（占6.01%）；其中，居前4位的病原菌分别是肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌。大肠埃希菌、肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)检出率分别为53.26%、31.10%；金黄色葡萄球菌和表皮葡萄球菌耐甲氧西林检出率分别为22.47%、80.00%，肠球菌耐万古霉素检出率为3.10%。肺炎克雷伯菌、肠杆菌科细菌对亚胺培南、美罗培南、厄他培南均高度敏感。鲍曼不动杆菌对亚胺培南的耐药率为79.48%,对美罗培南的耐药率为80.35%，对铜绿假单胞菌耐药率最低的是阿米卡星（10.70%）。G+球菌对万古霉素、利奈唑胺敏感性高。结论老年患者病原菌以G-菌为主，耐药情况严重，开展细菌耐药性监测，对指导临床合理使用抗菌药物，控制细菌耐药有重要意义。

Abstract:

ObjectiveTo investigate the distribution and antimicrobial resistance of clinically isolated pathogens from geriatrics department of a hospital in 2013, so as to provide reference for clinical antimicrobial use．MethodsDistribution and antimicrobial resistance of pathogens isolated from patients in a geriatrics department between January and December 2013 were analyzed statistically. ResultsOf 1 896 pathogenic strains, 1 289(67.99%) were gramnegative bacteria, 439 (26.00%）were grampositive bacteria, and 114(6.01%) were fungi; the top 4 isolated pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli. Extendedspectrum βlactamase (ESBL)producing Escherichia coli and Klebsiella pneumoniae accounted for  53.26% and 31.10% of Escherichia coli and Klebsiella pneumoniae respectively; Of Staphylococcus aureus and Staphylococcus epidermidis strains,  methicillinresistant isolates (MRSA and MRSE) accounted for 22.47% and  80.00%, respectively, of Enterococcus strains, vancomycinresistant isolates (VRE) was 3.10%,  Klebsiella pneumoniae  and Enterobacteriaceae were highly sensitive to imipenem, meropenem and ertapenem. Resistant rate of Acinetobacter baumannii to imipenem and meropenem was 79.48% and 80.35% respectively，Pseudomonas aeruginosa had the lowest resistant rate to amikacin (10.70%).Grampositive bacteria were highly sensitive to vancomycin and linezolid. ConclusionThe major pathogens isolated from the elderly patients are gramnegative bacteria, and antimicrobial resistance is serious, surveillance of antimicrobial resistance is important for rational use of antimicrobial agents and control of pathogen resistance.